Shimokawara Tatsuo, Shimomura Takahide, Okumura Yoshinari, Sakaki Toshisuke
Department of Neurosurgery, Seikeikai Hospital, Japan.
No Shinkei Geka. 2007 Apr;35(4):365-70.
We report 3 cases of de novo aneurysms that developed long after neck clipping of the initial aneurysms (range, 7 to 20 years, mean 12 years). Case 1 was a 58-year-old female who had undergone clipping of a ruptured aneurysm 17 years previously. Ten years later, she suffered another subarachnoid hemorrhage due to rupture of a new aneurysm, for which neck clipping was performed. Another seven years later, she had a third subarachnoid hemorrhage, and angiography revealed a new aneurysm, for which neck clipping was performed. Case 2 and 3 were both 68-year-old females who had suffered subarachnoid hemorrhage with two aneurysms and had undergone neck clipping for them respectively, 20 years and 12 years previously. Each patient was admitted to our hospital with complaints of headache, diplopia, vertigo, etc., and newly formed aneurysms were detected by magnetic resonance angiography. Conventional angiography revealed three and one new aneurysms, respectively. Since case 1 was a special case of multiple aneurysms in which lesions appeared in series rather than in parallel, all three patients harbored multiple aneurysms. It is recommended that patients with multiple aneurysms, especially those after a long period postoperatively, undergo periodic examination on an outpatient basis to detect formation of de novo aneurysms by magnetic resonance angiography or 3D-CT angiography.
我们报告了3例新发动脉瘤病例，这些动脉瘤在初次动脉瘤夹闭术后很长时间才出现（范围为7至20年，平均12年）。病例1是一名58岁女性，17年前曾因破裂动脉瘤接受夹闭术。10年后，她因新动脉瘤破裂再次发生蛛网膜下腔出血，并接受了动脉瘤夹闭术。又过了7年，她出现了第三次蛛网膜下腔出血，血管造影显示有一个新动脉瘤，遂进行了动脉瘤夹闭术。病例2和病例3均为68岁女性，分别在20年前和12年前因两个动脉瘤破裂导致蛛网膜下腔出血，并分别接受了动脉瘤夹闭术。两名患者均因头痛、复视、眩晕等症状入院，磁共振血管造影检查发现了新形成的动脉瘤。传统血管造影分别显示有3个和1个新动脉瘤。由于病例1是多发动脉瘤的特殊情况，病变是相继出现而非同时出现，所有3例患者均患有多发动脉瘤。建议多发动脉瘤患者，尤其是术后长期患者，定期门诊检查，通过磁共振血管造影或三维CT血管造影检测新发动脉瘤的形成。
